Megan's Diagnosis

Sitting on the plane right now and taking the chance to write about our visit today.

Today Megan had her three spots at the VPI clinic. The first was speech evaluation that determined she does in fact have VPI, evident by the hypernasality of her speech, and is a candidate for one of two surgeries. Her speech consult Linda Eblen was an awesome lady and so sweet to us. She is working as kind of the lead on Megan's case along with Dr.Sie.

So Linda was at her second appt with Dr.Sie. They put a spaghetti like scope up her nose and down to the top of her throat. Megan cried pretty hard initially at the extreme discomfort of this, but she did so good at calming herself down and rallying to finish with five mins plus of the tube in her nose.

There was a camera attached to the scope and we were able to watch what happened while Megan repeated words, sounds and phrases. In a normal throat, you would closure where the soft palate and the throat meet in most every sound. What they saw was the throat and palate touching on some occasions and not others, even when it did appear to close, there was still a small gap where air was escaping through the nose.

At this appt, Dr. Sie determined that surgery would definitely be the answer for Megan, she wasn't able to tell if it would be a throat or palate correction, but she would be able to determine that while in surgery. She would also like to put tubes in her ears at the same time if there is fluid present at the time, which there often is.

It was emotional for me after this second appt to actually see what happens in her throat while she's talking, that her inability to say certain sounds seemed out of her control and it just broke my heart.

The third appt was in radiology with Linda again. Megan was pretty worn out after the first two appts and a mixed up night of sleep, so she fell asleep about 20 mins before her next appt. Linda was so sweet and sensitive to her and her age and changed some appt times around and Megan was able to sleep for an hour and a half.

They inserted some barium up through her nose so that the sides of her throat showed up clearly on the x-ray. She really didn't like the stuff in her nose and just wanted to be done. Again, she did a great job of calming herself down and finishing up. For the x-ray, they did a front shot of her throat while she was talking and repeating what the speech therapist said. Then they did a side shot to see her palate while she was speaking.

After this test, Linda Eblen was less sure that she has VPI and maybe she has something called velopharyngeal-mislearned. From watching the x-ray test, it almost looked like her throat and palate were touching a lot of the time so she wasn't sure what the next step would be.

Linda wants to review all the tests again with Dr. Sie and decide what the right diagnosis will be for Megan. In the second test, they were able to see that even though the throat and palate appeared to be touching, there was still a small opening for air to escape.

So, right now, we have a surgery date scheduled for Megan on September 6th. It is about an hour long surgery and Megan would stay overnight.

Linda will call us next week after reviewing all of the tests with Dr. Sie and will make a final decision to go ahead with surgery or not.

Megan starts speech therapy at Healthquest this coming Monday and that is definitely something they want her to continue with while we wait.

We took our very first taxi ride ever back to the airport, it was great to just sit and not worry about traffic. We got to the airport and had some dinner together and then got on our plane. We both fell asleep, I slept hard for an hour and Megan slept for a couple of hours. Megan slept all the way home in the car and then went right to bed when we got home, I am so glad, she should feel pretty rested.

Thank you so much for praying!

Here is a description of the possible surgeries:

Speech surgery

There are several surgical procedures designed to treat VPI. All are performed inside the mouth under general anesthesia. Most times, the child needs to stay in the hospital overnight.
Speech with VPI after surgery

Speech with VPI after surgery.

At Children's Craniofacial Center the procedures performed most often are the Furlow palatoplasty and the sphincter pharyngoplasty.

The Furlow palatoplasty is designed to bring the abnormally positioned muscles of the palate into a more normal position so the palate can move better.

When doing a sphincter pharyngoplasty, the surgeon moves tissue from the back of the throat closer to the back of the palate.

A sphincter pharyngoplasty surgery is recommended when the surgeon decides that the palate is working as well as it can, but the back of the throat isn't moving correctly.

Sometimes a child will have minimal movement of the palate or the throat and may require both of these surgeries to be done at the same time.

Some patients who have surgery will still have VPI and may require additional surgery.